Testosterone Therapy
Publicly Funded Physician Service in Calgary for Men
Dr. jimmy Kwok, MD FRCPC
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Access
Testosterone therapy consultations are available by referral only. Ask your doctor to fax a referral to our office. Age 40 and up.
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Publicly funded service
Assessments and management of testosterone therapy are covered by your provincial healthcare plan. In-person visits only.
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Evidence-based Therapy
We provide evidence-based treatment, following the latest clinical guidelines for testosterone therapy recommended by Dr. Abraham Morgentaler, MD, FACS—co-author of the most recent Canadian Urological Guidelines. Dr. Jimmy Kwok is certified in the Morgentaler Method, having completed fellowship training directly under Dr. Morgentaler.
Testosterone Therapy In Calgary
Common Q&A about Testosterone Therapy in Men
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With mild gonadal steroid deficiency (10.4-12.1 nmol/L), fat accumulation begins.
When it drops down to < 7 nmol/L, there is a decrease in lean mass, thigh-muscle area and muscle strength.
Loss of sexual desire and erectile functions may occur with decreasing serum testosterone at various levels.
One may also sense a loss of vitality, loss of muscle strength and physical endurance. Many of these symptoms have been misidentified as normal aging.
Many studies showed that low levels are associated with increased CV risk while higher levels are protective. Mortality rates are reduced by half in those with deficiency receiving testosterone therapy compared with untreated men.
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The laboratory range sets the lowest limit at 8 nmol/L.
Most of the guidelines pick a cut off at 300 ng/dL or around 10 nmol/L because, for most symptoms, the average testosterone threshold corresponds to the lower limit of the normal (~300 ng/dl), with a greater likelihood of having a symptom below this threshold than above it.
Testosterone deficiency is a condition based on symptoms. The availability of T is also affected by the amount of sex hormone binding globulin SHBG and each individual’s receptor sensitivity.
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Acne
Gynecomastia/breast tenderness,
Fluid retention/pedal edema,
Erythrocytosis with a rise in hematocrit,
Infertility
Testicular atrophy.
A rise in serum PSA
Mild increase in blood pressure.
Some of these adverse reactions are related to the choice of treatment options.
knowledge is power
Myths about testosterone therapy
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This belief is based on three cases from a study in the 1940’s on patients with metastatic prostate cancer.
They had a subsequent increase in acid phosphatase with testosterone after castration.
Since then, there have been numerous studies on different population of men and show no solid evidence that testosterone causes prostate cancer.
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An elevated serum PSA does not necessarily mean that you have prostate cancer.
Consensus among most of the prescribers feels that it is reasonable to provide therapy if vigorous investigations have been performed to search for prostate cancer.
On the other hand, there has not been any single study yet for the use of testosterone on patients with elevated PSA. Treatment has to be individualized.
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This is NOT true.
There are a number of observational and cases studies showing that testosterone therapy provides a favorable outcome in survival with less chance of occurrence and increased latency period.
On the other hand, there is no long-term placebo control trial to prove its efficacy and safety yet.
Hopefully, there will be an answer in the future.
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There have been a few studies using testosterone therapy on patient with low grade prostate cancer.
There is no worsening of the malignancy when compared to those with the cancer but not receiving testosterone.
Even for those with biochemical recurrence, metastatic prostate disease or who were treated with androgen deprivation therapy for high risk of recurrence after definitive local treatment, testosterone therapy is not associated with precipitous progression of cancer.
High dose pulsating testosterone therapy is part of the treatment for resistant cancer.
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In many of the studies, the International Prostate Symptom Score (IPSS) showed no statistical significance between the treatment and placebo group.
There is a possibility that those on therapy may need more invasive procedures if needed.
There can also be a slight increase in your PSA level.
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The impression was originated from a few poorly conducted retrospective studies.
Subsequently, the TRAVERSE trial showed no increase in major adverse cardiovascular events compared with placebo. The observation is also supported by other studies.
Indeed, FDA has recently removed the black box warning of CV risk in testosterone therapy.
Some studies showed an association with deep venous thrombosis, pulmonary embolism, atrial fibrillation.
However, when studies are designed specifically to look for these adverse effects, no increased risk was found.
Indeed, there is lower incidence of AF with normalization of testosterone level in men.
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Testosterone has many benefits besides better sexual drive, energy and mood.
With normalization after replacement therapy, there is a significant decrease in all-cause mortality, myocardial infarction and stroke.
Other benefits include better clinic response in men women with heart failure, and exercise tolerance in men with exercise-induced angina.
It decreases fat mass and subsequently obesity but increases muscle mass and general physical activiites.
The replacement also helps to improve insulin resistance, reduce progression to type 2 diabetes, and increase remission of type 2 diabetes.
Additional benefits include improvement in mood, bone mineral density/strength, sense of vigor/vitality and resolution of unexplained anemia.
Low serum testosterone is associated with higher incidence of dementia and Alzheimer's disease.
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Testosterone replacement is aimed to restore your level of serum testosterone back to its physiological level. This is same as women on estrogen replacement therapy.
The anabolic and androgenic ratio is approximately 1:1.
We are not talking about anabolic steroids ,a synthetic version of testosterone, that are given in super high dosage to enhance muscle growth and performance. Its anabolic/androgenic ratio is 10:1.